背景:量化抗微生物药物耐药性的资源使用和成本确定了问题的严重程度并推动了行动。
目的:评估与欧洲六种主要耐药病原体感染相关的资源使用和成本。
方法:系统综述和贝叶斯荟萃分析。
方法:MEDLINE®(Ovid),Embase(Ovid),Econlit数据库,1990年1月1日至2022年6月21日期间的灰色文献。
方法:资源使用和成本结果(包括住院时间过长,总费用和其他超额/门诊费用)比较了由碳青霉烯耐药(CR)铜绿假单胞菌和鲍曼不动杆菌引起的确定的抗生素耐药感染的患者,CR或第三代头孢菌素大肠杆菌(3GCREC)和肺炎克雷伯菌,耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素的屎肠球菌以及对药物敏感或没有感染的患者。
方法:所有诊断为耐药血流感染(BSIs)的患者。
方法:NA。
■乔安娜-布里格斯研究所评估工具的改编版本,纳入病例控制,队列,和经济评估框架。
■分层贝叶斯元分析用于评估病原体特定资源使用估计。
结果:在5,969份筛选出版物中,37人被纳入审查。数据稀疏且异构。大多数研究估计可归因负担,比较耐药和易感病原体(32/37)。四项研究分析了因3GCREC血流感染(BSIs)导致的住院超额费用,从-2,465.50欧元到6,402.81欧元不等。八项研究提出了对MRSA和3GCRECBSIs(各4项)进行调整后的住院时间估计,允许进行贝叶斯层次分析,估计平均值为1.26(95%可信区间(CrI):-0.72-4.17)和1.78(95%CrI:-0.02-3.38)天,分别。
结论:严重缺乏关于大多数成本和资源使用结果以及大多数病原体抗性组合的证据。鉴于这些证据对理性决策的重要性,迫切需要进一步的研究。
BACKGROUND: Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action.
OBJECTIVE: Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe.
METHODS: A systematic
review and Bayesian meta-analysis.
METHODS: MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022.
METHODS: Resource use and cost outcomes (including excess length of stay, overall
costs, and other excess in or outpatient
costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection.
METHODS: All patients diagnosed with drug-resistant bloodstream infections (BSIs).
METHODS: NA.
UNASSIGNED: An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks.
UNASSIGNED: Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates.
RESULTS: Of 5969 screened publications, 37 were included in the
review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively.
CONCLUSIONS: Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.